Q: I have high blood pressure since five months and don't have any family history. I am taking blood pressure medicines like Amlod-At and Revas-H. Now I am better but sometimes I feel a bit discomfort in my left side i.e. I have a heavy feeling and coughing as well. During this time my blood pressure is 120/80. What is happening to me? Please help. This medicine, which I am having is very expensive and I can't afford it. Can I take any other medicine instead of this? If yes, please let me know the name?

A:You have been prescribed four medicines. Amlod-AT contains two medicines: amlodipine and atenolol while Revas-H also contains two other medicines: losartan and hydrochlorothiazide. Atenolol belongs to a class of medicines called betablockers. These medicines carry unacceptable risk such as triggering diabetes and hence are not to be used unless everything else fails. As per principles of good, evidence-based medical practice for patients below 55 years, the first line therapy should be enalapril (sold under the brand name of BQL, Enam etc.). If enalapril is not tolerated for any reason, then losartan (sold under the brand name of Losacar 50 mg daily) can be given. If after giving full therapeutic dose of either enalapril (or losartan in case enalapril is not tolerated), then a diuretic (the medicine that increases urine production and gets rid of excessive salt while independently lowering blood pressure) such as slow-release, low-dose indapamide (sold under the brand name of Indicontin Continus) can be added. Most patients adequately respond to two medicines if not one alone as stated above. In exceptional cases where two medicines are not adequate, one can use three medicines i.e. enalapril (BQL or Enam), a diuretic (Indicontin Continus) and losartan (Losacar). Rarely, in resistant cases, it is necessary to use four medicines. However the increase in the dose and number of medicines should be strictly on a stepwise basis i.e. give full dose of first medicine before adding second medicine. One should never start with four medicines. One can start with enalapril (BQL or Enam) at 5 mg once daily and increase to 10 mg and even 20 mg (10 mg twice daily) if response is not adequate. In case the full dose does not produce adequate response, one can add Indicontin Continus one tablet daily in the morning. It is highly unlikely that a third medicine will be required particularly in young, non-obese patients. Non-drug methods such as low salt intake and mild exercise (brisk walk for 45 minutes to cover no less than 4.5 km at least 5 days a week) should be followed concurrently.